You might owe higher Medicare premiums if you enrolled in Medicare late, or if you have a higher income. But everyone has the right to file an appeal about their premium determination. Understanding how higher premiums work can help you determine if your premium is accurate to your situation—or if you should appeal.
First, let’s discuss the Part B late enrollment penalty, or LEP, and how to appeal it.
For each 12-month period you delay enrollment in Medicare Part B, you will owe a 10% Part B premium penalty—unless you have insurance based on your or your spouse’s current work or are eligible for a Medicare Savings Program. In most cases, you will have to pay that penalty every month for as long as you have Medicare. However, if you are enrolled in Medicare because of a disability and currently pay premium penalties, once you turn 65, you’ll no longer have to pay the premium penalty.
Everyone has a right to file an appeal with the Social Security Administration (SSA) regarding their LEP. To appeal, follow the directions on the letter informing you about the penalty. You can appeal to remove the penalty if you think you were continuously covered by Part B or job-based insurance. You can also appeal to lower the penalty amount if you think it was calculated incorrectly. Unfortunately, being unaware of the requirement to enroll in Part B is unlikely to be a successful argument for an appeal.
Next, the Part D LEP and how to appeal it.
For each month you delay enrollment in Medicare Part D, you will owe a 1% Part D LEP, unless you:
Note that the Part D penalty is always calculated using that year’s national base beneficiary premium, which is about $36 in 2025. Your penalty will not decrease if you enroll in a Part D plan with a lower premium. In most cases, you will have to pay that penalty every month for as long as you have Medicare. If you’re enrolled in Medicare because of a disability and currently pay a premium penalty, once you turn 65, you will no longer have to pay the penalty.
Everyone has the right to file an appeal with C2C Innovative Solutions regarding their LEP determination. C2C Solutions is the company contracted by Medicare to handle these appeals. You can appeal the penalty (if you think you were continuously covered) or its amount (if you think it was calculated incorrectly). You should complete the appeal form you received from your plan, attach any evidence you have, and mail everything to C2C Innovative Solutions.
Finally, let’s discuss IRMAAs and how to appeal them.
The Medicare Income-Related Monthly Adjustment Amount, often shortened to IRMAA, is an amount you may owe in addition to your Part B and Part D premium if your income is above a certain level. Federal law sets income brackets that determine your—or you and your spouse’s—IRMAA.
|
Your annual income |
Your monthly premium |
||
|
Individuals |
Couples |
Part B |
Part D* |
|
Equal to or below $106,000 |
Equal to or below $212,000 |
$185 |
$0 |
|
$106,001-$133,000 |
$212,001-$266,000 |
$259 |
$13.70 |
|
$133,001-$167,000 |
$266,001-$334,000 |
$370 |
$35.30 |
|
$167,001-$200,000 |
$334,001-$400,000 |
$480.90 |
$57.00 |
|
$200,001-$499,999 |
$400,001-$749,999 |
$591.90 |
$78.60 |
|
$500,000 and above |
$750,000 and above |
$628.90 |
$85.80 |
If the Social Security Administration determines that you owe an IRMAA, they will mail you a notice called an initial determination. This notice should include information on how to request a new initial determination. A new initial determination is a revised decision that Social Security makes regarding your IRMAA. You can request that Social Security revisit its decision if you have experienced a life-changing event that caused an income decrease, or if you think the income information Social Security used to determine your IRMAA was incorrect.
Still have questions?
Your SHIP is here for you! You can contact your SHIP for any Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
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